Sexually Transmitted Diseases

What are the primary preventions for sexually transmitted diseases?

• condoms

• abstinence

• knowledge of partner

• reducing partners

• low risk sex

• vaccination

What is the most frequently reported STI?

Chlamydia

Is it possible for someone to have chlamydia & gonorrhea with no symptoms?

yes, it is possible

The high-risk population for chlamydia include:

• women younger than 25

• persons with new sex partners

• person with multiple sex partners

What are the treatment options for Chlamydia?

• Azithromycin 1 gram STAT dose

• Doxycycline 100mg BID x 7 days

What can cause a patient to not be able to take Doxycycline for treatment of Chlamydia?

if the patient is pregnant

What can happen if Chlamydia is left untreated?

it can lead to Pelvic Inflammatory Disease (PID)

What is Pelvic Inflammatory Disease (PID)?

it is when a organism ascends into the pelvic organs and infection spreads causing destruction

• can affect the uterus, fallopian tubes, etc.

What can happen if Pelvic Inflammatory Disease (PID) is left untreated?

it can lead to scarring in the uterus, fallopian tubes, etc.

If Pelvic Inflammatory Disease (PID) is left untreated and causes scaring, it increases the risk of what?

it increases the risk for ectopic pregnancy as well as tubal factor infertility (scarring in the fallopian tubes). 

What is Gonorrhea?

it is a sexually transmitted infection that infects the lining of the urethra, cervix, rectum, or throat, or the membranes that cover the front part of the eye (conjunctiva & cornea)

What other culture should have done if a woman has gonorrhea?

they should also have a culture done for chlamydia

What are some treatment options for gonorrhea?

• pt. >150kg (330ibs): Ceftriaxone(Rocephin) 500mg IM in a single dose

• pt. <150kg (330lbs): 1 g Ceftriaxone(Rocephin)

What is Syphilis?

it is a sexually transmitted infection that can progress through four stages (primary, secondary, latent, tertiary) if left untreated

• if untreated, can result in death

What is the symptom of primary stage of syphilis?

painless papule(chancre)

• pt. is “sore down there” that does not hurt

What is the symptom of secondary stage of syphilis?

• fever

• headache

• malaise (generally feeling bad)

• generalized lymphadenopathy (swollen lymph nodes in multiple areas of the body)

• maculopapular rash on the palms of hands and soles of feet

When does the secondary stage of syphilis occur?

it occurs 6 weeks to 6 months after contraction of infection

What is the symptom of latent stage of syphilis?

it is asymptomatic

What are the symptoms of tertiary stage of syphilis?

• neurological changes

• cardiovascular changes

• musculoskeletal changes

• multi-organ failure

• DEATH

What can happen if a pregnant woman has syphilis?

it can transfer from the mom to the baby through the placenta (transplacental transmission)

When should a woman be screened for syphilis when pregnant?

they should be screened for syphilis at their first prenatal visit

What are the tests for diagnosing syphilis?

• VDRL

• RPR

How long can it take for a syphilis test to come back positive after contraction of the infection?

it may take 6-8 weeks after contraction of syphilis for the tests to come back positive

What would happen next after a VDRL or RPR test came back positive for syphilis?

a treponemal confirmatory test will be preformed

What is the treatment for primary, secondary, and early latent stage less than 1 year after contracting syphilis?

• Benzathine Penicillin G 2.4 million units IM in a single dose

• Pregnant women: a second dose of benzathine penicillin 2.4 million units IM can be administered 1 week after the initial dose

What is the treatment for latent stage of syphilis greater than 1 year, or contraction is unknown?

Benzathine Penicillin G 2.4 million units IM in 3 doses each at 1-week intervals

What are the treatments for pelvic inflammatory disease (PID)?

• Ceftiaxone (treats Gonorrhea)

• Doxycycline or Azithromycin (treat chlamydia)

• Metronidazole (treat Bacterial vaginosis)

What is the most common STI in the US?

Human Papillomavirus (HPV)

What are some of the symptoms of Human Papillomavirus (HPV)?

• irritating vaginal discharge with itching

• dyspareunia (persistent or recurrent genital pain)

• postcoital bleeding (bleeding after sex)

• genital warts

What is the screening for Human Papillomavirus (HPV)?

an annual exam/pap smear screen for cervical cancer but also screens for HPV

What happens if Human Papillomavirus (HPV) is detected during a pap smear?

the frequency of pap smears may be increased

What should you educate the patient on when it comes to putting medications on the genital warts caused by Human Papillomavirus (HPV)?

tell pt. to be very careful to avoid the surrounding healthy tissue- the meds will cause irritation to the healthy tissue if exposed

What happens to the genital warts from Human Papillomavirus (HPV) during pregnancy?

the warts often grow in size/quantity

Is Herpes Simplex virus 1 (HSV-1) transmitted sexually or nonsexually?

it is transmitted nonsexually

• oral lesions

Is Herpes Simplex virus 2 (HSV-2) transmitted sexually or nonsexually?

it is transmitted sexually

• genital lesions

What are the symptoms of Herpes Simplex Virus (HSV)?

• can be asymptomatic

• painful lesions-blisters or ulcers

• fever

• chills

• malaise

• dysuria

• tingling or shooting pain in the legs, hips, and buttocks before lesions appear

How is Herpes Simplex virus (HSV) diagnosed?

• Gold Standard=culture of suspicious lesion

• serum labs can be drawn to detect antibodies of a past infection

Is Herpes Simplex Virus (HSV) curable?

it is NOT curable

How are Herpes Simplex Virus (HSV) symptoms managed?

they are managed by antivirals

• Acyclovir (Zovirax)

• Valacyclovir (Valtrex)

Can Herpes Simplex Virus (HSV) still be transmitted even if outbreak is no present?

it is still transmittable

What can happen in the first trimester of pregnancy if a women contracts Herpes Simplex Virus (HSV)?

there is an increase rate of miscarriage

Can antiviral medications for Herpes Simplex Virus (HSV) be used safely during pregnancy?

it can be used safely in pregnancy

When is suppressive therapy for Herpes Simplex Virus started for pregnant women who have a history of HSV?

it is started at 36 weeks of pregnancy

What type of birth is indicated if a pregnant woman is having active genital lesions during delivery?

a c-section is indicated

What is hepatitis A?

• acquired primarily through fecal-oral route

• ingestion of contaminated food

• person to person contact

• vaccination is most effective means of preventing Hep A transmission

What is hepatitis B?

• most threatening to fetus and neonate

• disease of liver potential; often a silent infection

• transmitted parenterally, perinatally, orally (rarely), and through intimate contact

Is it okay to breastfeed if a women has hepatitis B?

it is okay to breastfeed

Transmission of hepatitis B to newborn can be prevented if hep B immunoglobulin and Hep B vaccine is given within how many hours of birth?

12 hours of birth

What is hepatitis C?

• most common bloodborne infection in United States

• high risk groups are screened in pregnancy as can be harmful! High risk groups=( hx IV drug use, etc)

• maternal transmission is rare but increased risk of mother also HIV+

• currently there is no vaccine but treatment are emerging

Positive HIV results are reported to where?

it is reported to the state

How are HIV positive test results given?

they are given face-to-face, not over the phone

What type of tests and vaccinations are offered if someone is HIV positive?

• TB testing

• Hep B vaccine

• flu vaccine

Can a women breastfeed if she has hepatitis C?

no because it can cross the placenta and into breast milk

What are the symptoms of Trichomoniasis?

• greenish/yellow vaginal discharge that is often frothy in appearance.

• strong fishy vaginal odor

• painful urination

• vaginal irritation and itching

• dyspareunia (persistent or recurrent genital pain)

• “strawberry cervix”: the inflammation that is caused by the infection will cause the cervix to have a strawberry look

• Spotting between menses or with intercourse-due to the friability of the cervix

What are the treatments for trichomoniasis?

• Metronidazole (Flagyl) 500 mg BID for 7 days for women.

• Metronidazole (Flagyl) 2 g PO in a single dose for men.

• Tinidazole 2 g orally in a single dose as an alternative treatment for men and women.

What are some patient teachings for a patient taking Metronidazole for trichomoniasis?

tell pt. side effects include:

• headaches

• abdominal pain

• tremors

• flushing

• N/V

What are the symptoms of bacterial vaginosis (BV)?

• fishy vaginal odor

• thin, milky white discharge

What medication is used to treat bacterial vaginosis (BV)?

Metronidazole(Flagyl) vaginal gel or oral dosage. 

• Oral-500mg BID x 7 days

What are the predispositions for candidiasis/vulvovaginal candidiasis/yeast infection?

• antibiotic therapy

• diabetes

• pregnancy

• obesity

• diets high in refined sugars

• use of corticosteroids

• immunosuppressed states

What are the symptoms of candidiasis/vulvovaginal candidiasis/yeast infection?

• thick white clumpy discharge- cottage cheese appearance

• dyspareunia

• extreme itching

• vaginal irritation and/or redness

What are some treatment options for candidiasis/vulvovaginal candidiasis/yeast infection?

• antifungal cream

• fluconazole(Diflucan)

What is Group B Streptococci?

it is a bacteria that can live in the vagina and not cause any harm, and the women will likely be asymptomatic.

When are pregnant women screened for Group B Streptococci?

they are screened at 36 weeks of pregnancy

What happens if a pregnant women test positive for Group B Streptococci?

they will be given IV antibiotics in labor

What is TORCH titers?

it is a blood test that tests for certain diseases like Varicella, Rubella, Fifths disease, Herpes, Toxoplasmosis, Cytomegalovirus